This is an archive of the Treatment Action Campaign's public documents from
December 1998 until October 2008. I created this website because the TAC's
website appears unmaintained and people were concerned that it
was becoming
increasingly hard to find important documents.
The menu items have
been slightly edited and a new stylesheet applied to the site. But none of the
documents have been edited, not even for minor errors. The text appears on this
site as obtained from the Internet Archive.
The period covered by
the archive encompassed the campaign for HIV medicines, the civil disobedience
campaigns, the Competition Commission complaints, the 2008 xenophobic violence
and the PMTCT, Khayelitsha health workers and Matthias Rath court cases.
7 September 2006
Released 22:30 (GMT+2)
On Friday 8th September 2006 - the South African government in particular the Minister of Health and the Minister of Correctional Services and their employees have to submit a treatment plan for inmates with HIV/AIDS at Westville Correctional Centre to the Durban High Court. Government has already been held in contempt of court. Now, it has the opportunity to demonstrate what Cabinet today promised would never again be breached - that is, respect for the Constitution and the rule of law.
The Constitution and law requires that the HIV/AIDS plan for Westville Correction Centre must be reasonable. A reasonable plan has at least four elements according to the Constitutional Court.
The HIV/AIDS plan for Westville and any health district in our country must be reasonable in conception. This means the plan must eliminate all barriers to HIV/AIDS prevention, treatment and care. It must have clear budgets, resource needs allocation including training, support and evaluation.
The plan must also be implemented reasonably - a beautiful policy on paper and not properly implemented will be unconstitutional.
Reasonable coverage by the plan means reaching all those who need treatment but special consideration must be given to vulnerable and marginalised groups.
A plan must be communicated to everyone in a reasonable manner.
The elements of a reasonable plan were identified by the Constitutional Court in the Grootboom and TAC cases.
Background:
South Africa's prisons are in crisis. Overcrowding, malnutrition, lack of adequate health-care services and a general absence of recreational, educational and work programmes all require urgent attention.
The number of prisoners who have died in custody from natural causes has risen dramatically from 211 in 1996 to over 1500 in 2005. The death rate in prison has increased from 1.65 deaths per 1000 in 1996 to 9.2 per 1000 in 2005. This increase in the prison mortality rate is directly attributable to HIV/AIDS and its intersection with tuberculosis (TB).
Fundamental Right to HIV Treatment of Inmates:
A clear, unambiguous commitment from government on how inmates with HIV/AIDS will receive treatment and how their health, including their mental health, will be maintained must be stated.
This commitment must at minimum be based on the Constitution and the Correctional Services Act.
The plan must state how it will be communicated to inmates, staff, health professionals and families of inmates on a sustained basis.
Environment:
Overcrowding in prisons is dangerous and wide-spread. Thirty-eight prisons are operating at 175% occupation, with several at around 300%. In Johannesburg Medium B Facility, for example, overcrowded conditions resulted in inmates having to sleep in the toilet area.
Overcrowded conditions are harmful to health. It also transmits illnesses like tuberculosis, meningitis and hepatitis that are easily transmitted through close human contact.
Inmates with tuberculosis must be removed to less crowded conditions if we are to avoid a crisis of TB, Multi-drug resistant TB (MDR-TB) and even extensively drug resistant tuberculosis (XDR-TB, see below).
These illnesses are harmful to inmates, corrections staff and the families of inmates.
Prevention access:
Condoms must be made widely available in prisons, in order to prevent the further spread of HIV and other sexually transmitted diseases. At present access to prophylactics is usually restricted or non-existent. The plan must stipulate how many condoms will be made available.
Inmates have the right to access condoms as a health provision and HIV positive inmates have a duty to use condoms to prevent harm.
Access to HIV Testing is necessary to access treatment:
Voluntary counseling and testing must be made easily available to all inmates who request it. There must be a clear plan of service provision of testing especially to sentenced inmates and any person awaiting trial for more than three months.
The provision of HIV testing should be accompanied by a campaign to educate inmates on the benefits of regular HIV screenings.
Furthermore, in line with international recommendations testing should be routinely offered to any inmate who needs health care. Such testing must be premised on access to treatment.
Every inmate sentenced or unsentenced who has HIV/AIDS must be given a CD4 count on a regular basis.
Prevention and Treatment Literacy:
Inmates must be provided with the opportunity to undergo comprehensive Treatment Literacy training so that they can make choices about their health based on extensive background information.
The Treatment Action Campaign has offered its support in this endeavour and is willing to provide materials (including copies of our booklets HIV In Our Lives and ARVs In Our Lives) as well as trainers.
Nutrition
Despite legislation governing the quality of food and the timing of meals, inmates report receiving only two meals a day, of food that is unhealthy in both quantity and quality and often badly cooked.
All inmates, but particularly those living with HIV or TB, must receive at least three meals per day, at appropriate intervals. The food must be of good enough quality so as to ensure the health of inmates.
The department must provide details on times that inmates receive adequate nutrition at all meals.
Exercise:
Inmates with HIV/AIDS must be given additional opportunity to exercise, as an integral part of maintaining good health.
ARVs
Three years after government adopted its Treatment Plan most inmates who need ARVs still cannot access them. Many are dying. Even those who do take them often start too late, are not properly monitored and are given insufficient counseling and treatment awareness.
Antiretroviral drugs must be provided to all inmates who need them.
The plan must set clear targets for ARV treatment for all inmates - all unreasonable barriers including access to ID documents must be removed.
The process for allowing this to happen must include swift accreditation of appropriate sites, comprehensive and easily accessible medical support for inmates taking ARVs and significantly improved counseling and treatment literacy.
TB
Tuberculosis in correctional facilities is a problem recognized internationally.
Co-infection of HIV and TB results in bad quality of life and increased risks of death.
TB, multi-drug resistant TB (MDR-TB) and the newly emerged extensively drug resistant TB (XDR-TB) are serious problems further exacerbated by HIV.
TB diagnostic procedures should be improved so that smear negative TB (very common in HIV positive patients) is detected and treated.
TB treatment should be available and closely monitored. Second line drugs should be prescribed if necessary, and adherence to the full course of medication ensured by appropriate means. Interruptions of drug supplies has been reported by inmates as the main reason for failure to complete or maintain treatment.
Occurrences of MDR-TB and XDR-TB should be closely monitored and contained.
Release Protocol
Clearly defined structures must be put in place in every prison to ensure that on their release inmates continue to be able to access ARVs, TB drugs and other medication from the state.
This referral process should be simple and all-inclusive.
It must include prisoners who have spent time in prison awaiting trial and are then released without sentence.
This must include proper communication with the family of inmates with HIV based on consent to communicate HIV status before they are released.
Special Needs
Special consideration must be given to supporting vulnerable groups, particularly women, children and gay men who enter correctional facilties.
Inmates with physical and mental health conditions that require ongoing treatment must also be catered for.
Inmates with disabilities must be reasonably accommodated in prevention and treatment programmes.
Several areas of policy need urgent resolutions if any of the above areas are to be properly addressed.
Responsibility for the health of inmates must be clearly assigned to the Department of Health, which must take responsibility for any inadequacies in health provision.
There must be a plan to ensure effective coordination between the Department of Correctional Services and the Department of Health.
There must be leadership from both Ministers - accountability is an essential part of this.
TAC believes that the only reasonable option for the President is to appoint a competent, compassionate and rational Health Minister.
Prison health facilities must be accredited as ARV sites as soon as possible.
These requirements are based both on government standards and on what has been submitted to the Court by the Treatment Action Campaign and the AIDS Law Project.
TAC extends its support to the Department of Correctional Services to implement this plan and to make Westville Corrections Centre a model HIV prevention and treatment centre.
The NEC and members of TAC commend the inmates of Westville for their struggle and we especially thank the AIDS Law Project - our attorneys of record. TAC also thanks Ms Sue Pillay - the correspondent attorney for the ALP, Advocate Andrea Gabriels and Advocate Wim Trengove SC. Thanks to TAC KZN for great work on this case.
We hope that government will avoid unnecessary litigation in future.
[END OF STATEMENT]